MEDICARE: PALO VERDE PHYSICAL THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	4214	AZ
2	261QP2000X	Physical Therapy Clinic/Center	1526	AZ

General Provider Information

NPI Number	:	1225033483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALO VERDE PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	3003 HIGHWAY 95
Second Line	:	STE 61
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-7896
Country	:	US
Telephone Number	:	928-758-0029
Fax Number	:	928-758-0055

Provider Business Practice Location Address
First Line	:	3003 HIWAY 95
Second Line	:	STE 61
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-7896
Country	:	US
Telephone Number	:	928-758-0029
Fax Number	:	928-758-0055

Authorized Official
Title or Position	:	OWNER
Name	:	CAROL DIEHL
Credential	:
Telephone Number	:	928-758-0029

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	10/31/2007

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Directions to “PALO VERDE PHYSICAL THERAPY ” Practice Location

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